Passport to Adventure Camp Registration/Waiver Form

PLEASE READ CAREFULLY

Child's Name

First NameLast Name

Birth Date

MonthDayYear

Grade

Gender

MaleFemale

Address

Street Address

Street Address Line 2

CityTerritory/Province

Postal Code

Child's Health Care Number:

Parent/Guardian Information

Name

First NameLast Name

Home Number

Cell Number

E-mail

example@example.com

Emergency Information

Emergency Contact's Name

First NameLast Name

Relationship

Phone Number

Alternative Phone Number

Alternative Pick Up Person

Will someone other than parent/guardian be picking up your child from camp?

Does your child have any medical needs that we need to be aware of? Any medication? Allergies? Use of an inhaler? Dietary considerations?

Please describe any social or emotional needs that your child has and the supports that they require. Please indicate if your child will have a support person and indicate if the support person has an up to date criminal records check.

The camp registration fee is $175. If financial assistance is required to pay for registration, please indicate YES below.

Photos

I, the parent/guardian of the participant, do give permission for photos that include the participant in it, to be used for display in things such as the church bulletin board, the Good News newsletter (church quarterly newsletter), projection (during a church service) and online media (church website or streamed church service.)

DISCLAIMER
Riverdale Baptist Church, its leaders, directors, officers, employees, contractors, agents, volunteers, members and representatives (collectively referred to as the “CHURCH”), are not responsible for any injury, loss or damage of any kind whatsoever sustained by any person or their property while participating in events, activities or travel with the “CHURCH” and all related activities associated with the “CHURCH”, including injury, loss or damage.

ASSUMPTION OF RISKS

IN CONSIDERATION OF the “CHURCH” allowing me or my child to participate in events, activities, or travel with the “CHURCH” and all related activities associated with the “CHURCH” including participation in the Adventure Camp and all activities related to the Adventure Camp (collectively referred to as the “Activities”), I acknowledge that I am aware of the possible RISKS, DANGERS AND HAZARDS associated with participation in the Activities including the possible risk of severe or fatal injury, loss or damage. These risks include but are not limited to the following:

The risks associated with travelling to and from the Activities by means of private or public transportation, which may include, but are not limited to a motor vehicle accident resulting in physical injuries or death
Medical problems arising before, during or after the Activities
Injury, damage or loss due to failure to follow the instructions or directions of the persons in charge of the Activities

I, for myself or my child, voluntarily accept and fully assume all such risks, dangers and hazards and the possibility of personal injury, death, partial or permanent disability, property damage or loss resulting from my or my child’s participation in the Activities.

RELEASE OF LIABILITY and AGREEMENT
IN CONSIDERATION OF the “CHURCH” allowing me or my child to participate in the Activities, I agree on behalf of myself and/or my child:

1. TO ASSUME and ACCEPT ALL RISKS arising out of, associated with, or related to my or my child’s participation in the Activities.

2. TO WAIVE and RELEASE the “CHURCH” from any and all liability for any loss, damage, injury or expense that I or my child may suffer, or that my next of kin may suffer as a result of my or my child’s participation in the Activities due to any cause whatsoever.

3. TO INDEMNIFY and HOLD HARMLESS the “CHURCH” from any and all liability for any damage to the personal property of, or personal injury to, any third party resulting from my or my child’s participation in the Activities.

4. TO INDEMNIFY and HOLD HARMLESS the “CHURCH” from any and all claims, demands, actions and costs for any loss, injury, damage or expense whatsoever that might arise out of my or my child’s participation in the Activities.

PARENT OR GUARDIAN PARTICIPATION CONSENT

Acknowledgement of Parent or Guardian of Participant:

We, the undersigned parents or guardians of the participant, hereby authorize and consent to the participant’s involvement in the Adventure Camp, including any use of private or public transportation deemed necessary by the persons in charge of the Adventure Camp for participant travel to and from Adventure Camp activities, or to the NEAREST SUITABLE MEDICAL or HOSPITAL FACILITY in the event that emergency or other medical treatment is not available at the site of an Adventure Camp activity. We hereby consent to and authorize such emergency or other medical treatment of the participant as may be deemed advisable in the event of accident, injury, or illness during the activities of the Adventure Camp.

ACKNOWLEDGEMENT and SIGNATURE

I HAVE READ AND UNDERSTAND THE TERMS OF THIS AGREEMENT and I ACKNOWLEDGE THAT by signing this agreement voluntarily, I am agreeing to abide by its terms, and I am waiving certain legal rights that I or my child may have.

This Consent, Authorization and Acknowledgement shall be effective from and including July 7 to and including July 11, 2025.

Date

Signature of Parent or Guardian

Witness to Signature of Parent or Guardian

We will be in touch shortly after receiving your child's camp application to confirm their spot. Payment information will be provided at that time.

Registration and Waiver

Child's Information